Strong emotions often push us to act without weighing consequences, simply because we feel helpless and need to take action; that’s why the world has so many unworn expensive shoes, memorial tattoos, and children born just before or after their parents’ divorce. In reality, we’re often screwed no matter how we choose to react, or we’re just panicking for no reason and no action is required in the first place. In any case, no matter the emotional forces, think first and act later, weighing your alternatives and acting only if you think it’s necessary. You might not feel any immediate relief, but in the long run, you won’t have anything (or anyone) to regret.
–Dr. Lastname

My grown son has always been very difficult, but his last outburst was just too much. He caught me at a time when I was having a tough time and felt vulnerable, and I told him I thought he was being a selfish, self-centered little shit, so he told me never to talk to him again and hung up. Unfortunately, even if I shouldn’t have said those mean things out loud, I was right; he’s a jerk, so none of his friendships has lasted and his kids are very careful not to aggravate him. Even though I feel really guilty about it, I just can’t bring myself to pick up the phone or write him and try to patch things up. I know that if I don’t reach out to him, I won’t see those kids, but if I do, I’ll have to have a conversation with him, which is just going to be unpleasant and end badly. My goal is to figure out a way to repair our relationship so I won’t dread talking to him or feel bad about being such a heartless parent.

The good news is that you’re living evidence that Asshole™-ishness isn’t always genetic. The bad news is that you have still spawned an Asshole™.

As we’ve said before, Asshole™s can cause serious harm without any real provocation; they’re usually very needy, and their neediness causes them pain that they think is your fault, particularly if you’re a parent or other person who stirs up those feelings by virtue of your very existence.

In this day and age, it’s almost impossible not to know what Attention Deficit Disorder is (or to not have a direct connection to someone who has it, or to not have an opinion on it, just because). On the other hand, very few people are aware of Attention Surfeit Disorder, which is when people habitually get so perfectly focused on the problems that grab them that they can’t see why anything else matters, even if it’s a looming disaster. Whether you can’t focus on any one thing or focus far too much on one thing exactly, be aware that our brains have different ways of focusing, and that each has its own strength and weakness. Then, whether you have a fun diagnosis or not, you’ll be better at managing your priorities instead of following whatever captures your attention.
–Dr. Lastname

I’m curious to your thoughts on subclinical anorexia. I was (voluntarily) hospitalized with anorexia nervosa last year. Since then I’ve managed to keep my weight out of the danger zone, but not up to where my physicians would like it. Honestly, I don’t see the point. Even at my lowest weight I completed an MPH at Hopkins (my third post-graduate degree), I’m in the “healthy” BMI range, technically, and I hold a full time job in addition to teaching science at a local University two nights a week. Who the hell cares if I don’t hit my target weight? My goal is to continue to achieve excellence without worrying too much about what doctors tell me about my weight.

When you focus too much on perfection in one particular aspect of your life, be it in terms of appearance or professional achievement, it’s like searching for a house based on the quality of the faucets; you become so fixated on the gleaming chrome that you don’t notice the lack of square footage, light, or even plumbing.

Obsessional, single-minded focus is always unhealthy when it gets you to disregard whatever else is truly important in your life, like your health and friendships. You tell yourself it’s good to work harder to make yourself better…while losing track of the fact that what you’re sacrificing is worth more than the excellence you’re driven to achieve. WAIT! There is more to read… read on »

We’re all familiar with the ol’ break-up mantra, “it’s not you, it’s me,” which can also apply when you’re having repeated issues with a loved one. Sometimes, however, it’s worth considering whether it’s not you, but them; sure, sometimes there’s nothing wrong in a relationship other than the feelings they leave you with, but other people who look normal have subtle problems that can’t be changed. Instead of responding to your instincts about normality, weirdness, and responsibility, learn to accept your observations, discount your feelings, and think hard about where you think things need to go. Then you’re much more likely to come up with action or non-action plans that will best serve your needs, and turn them and you into a more functional “us.”
–Dr. Lastname

My ten-year-old daughter is sloppy about her homework, but I don’t let her watch TV until she’s done it properly, so it’s past her bedtime so she never gets to watch her programs and she’s mad at me. At that point I’m mad at her, because I don’t like being the evil mother and she could easily do her homework in a fraction of the time if she was just a little more careful in the first place. Her teachers also say she blurts out answers before she thinks and makes herself look foolish. My goal is to get her to take care with her homework and get it done properly the first time, so we don’t have to struggle through the rest of the evening.

Both you and your daughter seem dedicated to getting through this homework situation, as evidenced by the fact that you’ve both made the ultimate sacrifice; you’ve given up your precious evening relaxation hours, and she’s given up prime time television.

What you need to ask yourself, however, is whether her sloppiness and foot-dragging are due to low motivation and stubbornness or a glitch in the way she learns new information, because your sacrifices—your time on the couch with wine, her “Vampire Diaries”—may be in vain if her brain doesn’t do homework well and she’s feeling like a failure. WAIT! There is more to read… read on »

From Mama Rose to your average scary hockey dad, pushy parents who steamroll their kids into living out their own dreams are seen as monsters who seldom inspire real motivation. Pushing a relatively unmotivated kid into therapy instead of the spotlight might not make you feel like Dina Lohan, but the fact is, an enthusiasm gap between parent and child never bodes well. It doesn’t necessarily mean that your kid is an unmotivated, treatment-rejecting slacker, but it does mean that the intensely emotional intervention of a caring parent, whether offering treatment, discipline, or both, can make a child too reactive to others’ motivations to discover his or her own center and strength. When you want to help a difficult child, you must also learn to sell your child on the values of patience and self-restraint through example, waiting for your child to meet you halfway. Pushing a child to be mentally healthy is more valid than pushing her to be a superstar or pro-athlete, but if she don’t want it as much as you do, all you’re doing is pushing her away.
–Dr. Lastname

My daughter’s therapist is extremely expensive (hundreds of dollars, and he doesn’t take our insurance), but my daughter said the sessions helped her with her depression when it seemed like no one and nothing else could, so my husband and I took out a loan and paid for weekly treatments, which started when she was in high school and continue over the phone now that she’s in college. At the end of last semester, however, she’d flunked out of a course and now says she needs more money for personal expenses, and my husband and I have reason to think she’s drinking and partying way too much. We’re furious and my husband doesn’t want to keep “throwing money away,” especially since it’s money we have to borrow, but I’m afraid that if we confront her or reduce support for her treatment she’ll get even worse, drop out of school, and never get her degree or her mental health in order. My goal is to figure my way out of an impossible dilemma.

Ironically, endlessly searching for ways to keep your daughter safe is, in itself, a fairly dangerous proposition; if you make yourself too responsible for her treatment, she won’t develop her own values and reasons for using it and accepting its limitations. You can lead the kid to therapy, but you can’t make her think.

Until she builds her own foundation for managing her illness and its treatment, your recovery plan remains shaky. It gets shakier the more it depends on your efforts and the availability of therapists who may or may not be there when you need them, no matter what their cost. WAIT! There is more to read… read on »

People who knowingly distort the truth seem to deserve more blame than those who truly believe what their mind makes up, but when you’re close to a liar, the issue isn’t who deserves more blame, but who is more dangerous to your welfare. Somebody who lies on purpose often does so out of a guilty conscience, while those who believe in their lies are more apt to see you as. the deceitful one who’s deserving of blame and punishment. So when lying is an issue, don’t waste time on how it makes you feel or whether the truth needs to be told. Instead, look at what happened when the liar was exposed in the past and do what’s necessary to protect yourself, even if it means leaving a liar behind, and as such, the truth unspoken.
–Dr. Lastname

My husband has a porn problem– problem because he hides it, lies about it, and blames it on others (as in, “Oh, my friend sent me some virus and that’s what opened the browser window to the helpful find-a-local-hooker site”). He also has a deadline and personal responsibility problem– lots of promises to accomplish tasks at home, precious little success. I still find benefits from being married to him. He works hard and his income is very useful. He has been sober for twenty years now, and if he is screwing around on me he is doing it discretely. He is vital to the childcare and child transportation scheme. He can be pleasant to be with and supportive, and our sex life is good. And I am 50, fat and tired and figure I would face a life of lonely celibacy without him. I can generally cope with the down side of things, but I persist in feeling angry and disappointed when he once again lets me down, and every once in awhile I find myself believing that someday he’ll change. I’m worried that I may have my thumb on the scale when I weigh the pros and cons of sticking with him. I also worry that our kids might be better off without the toxic atmosphere when I am once again disappointed. I need help finding ways to cope with the inevitability of being let down, and the serenity prayer just ain’t doing it.

It’s hard not to experience being lied to as a personal betrayal of trust, whether the liar is close to you, like a husband, or a stranger, like a politician with an unfortunately phallic last name. The reason liars can take any form, however, is that as personal as the act feels, it’s often nothing but a bad habit.

After all, nose-pickers aren’t trying to gross you out, nervous whistlers aren’t trying to annoy the shit out of you, and alcoholics aren’t getting shitfaced just to make your life more difficult. You feel like you’re in the crosshairs, but you’re just collateral damage. WAIT! There is more to read… read on »

It’s often been said that if you want to make god laugh, make a plan, but this is not the case for people dealing with mental illness, mostly because of all the pain you have to accept before you even get to the plan-making stage. If you ignore that pain, you’re a dumb ostrich who will make an avoidant plan, but if you focus too much on it, you develop a ruminative plan and become your problem. So brace yourself for unavoidable pain, prepare to do two things at once, and plan away. Then your choices will take you as close as possible to where you want to be, and your plan, or at least your ability to make one, will make any higher power proud.
–Dr. Lastname

I have a big problem getting myself to study. I do things late and then don’t get good grades, or I don’t get anything done, or I stop somewhere in the middle. I guess I have a problem with concentration and also with laziness. I’ve also done this thing since I was a little child where I turn on music, I sit on a couch or my bed and rock myself, hitting my back towards the backrest of the couch, sometimes it takes hours, sometimes it’s quite quick, like half an hour. I also have quite low self-esteem, not sure what is the reason…I am trying to overcome it somehow but it always gets to me again and I have to deal with it and then I have these days like I do not want to get up—I can’t think of a reason to, and I do not want to go anywhere and I am scared of everything. Sometimes I feel like people are watching me and criticizing me and I don’t want to go to the market because I don’t want to deal with anyone. Sometimes I eat a lot because I am in that crazy mood and I feel bad about it, not because I’ll gain weight (maybe a little bit) but especially because of my health… I criticize myself a lot. I write something or say something and in a while I hate it even if the first impression about it was really good. So… I might be a little bit screwed up I guess… I would be thankful for some opinion or advice what to do with all this.

You’ve certainly got a ton of problems, including trouble concentrating, studying, getting up in the morning, keeping your weight under control, dealing with paranoid thoughts, etc. (but hopefully not memory, because I’d have to think there are even more issues you forgot and left out).

The big question to ask yourself, however, is not what’s wrong with you and to count all the ways, but what you’ve done with your life in spite of these problems. WAIT! There is more to read… read on »

Deciding whom to blame for a problem you can’t get a handle on is easy if you follow your instincts, but instincts should also tell you that a decision made based on intuition instead of thought is probably wrong. In reality, you need to look carefully at whether a person is doing his or her best with what’s actually controllable before deciding whether what’s missing is better discipline or better luck. Ignore your instincts, assess the uncontrollable and you’ll come up with helpful and constructive ideas by looking for facts, not blame.
–Dr. Lastname

I’m in college, and my problem is that I have ADD and even when I’m on Ritalin, I get distracted very easily if something about a course is hard to understand. Then I wind up fucking around, doing other things, spending too much time with my boyfriend, and falling behind. After two or three weeks, it’s too hard to catch up and I don’t want anyone to know, so I stop going to class. A few weeks after that, there’s nothing to do but drop the course, which makes me feel like a loser. I had the same problem in high school, but I’ve never found a drug or dose that’s made the problem better. My goal is to find a better medication or a way to try harder so that I don’t get behind in the first place.

There’s no doubt ADD is your problem, but another problem lots of people with ADD develop over the years of experiencing learning as a painful, humiliating process is avoidance. It came from your ADD, but it’s its own problem, and not the kind they make pills for.

A lot of people with ADD get good at lying to themselves and others about what they’re failing to do and what the consequences are going to be. It started as a coping mechanism, but it’s developed into a pain in the ass. WAIT! There is more to read… read on »

Macho sports-types like to say that failure is not an option, and in a totally not-macho way, they’re absolutely right. After all, we all have different definitions of success, and while individual skill is a factor, so are luck, fate, and a mess of other circumstances that we can’t control and/or overcome completely. So if you can’t meet certain expectations or fix pressing problems, the good news is, failure is not an option; if you do your best with whatever it is you actually control, judging for yourself what that is, you can never lose.
–Dr. Lastname

At this point in my life I’m not sure in which direction to turn. I am a 37-year-old female going through a divorce, had to move back home and just failed nursing school by just a few points in my final semester. I was so devastated about failing nursing school that I basically fell off the grid for a while. Many of my peers feel as though the school was unfair and are encouraging me to fight this, and I have hired attorneys who have sent letters to the school and are now talking about litigation. All of this is starting to become so overwhelming that I feel like I am starting to spin into a deep depression again. It is so hard to watch everyone around me succeed and pass me by in life. My question is this, should I go on with fighting the school and sink more time and energy into something I’m uncertain of? Or should I just throw in the towel and try something else. I am so conflicted and would love just a no nonsense straight answer without all the fluff. Any insight would be so appreciated.

People feel like failures when they fall behind the achievements of their over-achieving peers, but, by the age of 37, you’ve earned the right to define your progress, or lack of it, in your own terms, regardless of what your school thinks.

Of course you hate to watch your friends pass you by, but don’t ask yourself why you’re not keeping up with them. Instead, ask why you’re wasting time comparing yourself to them instead of asking yourself where you stand according to your own standards, and what you want to do next. WAIT! There is more to read… read on »

The fact that treatment is seldom as good as we want or need it to be isn’t so bad. If we can’t always make things better with treatment, and we’re willing to accept that fact, we’re no longer burdened with responsibility for figuring out answers and making things better in the first place. Our real job isn’t finding a perfect cure for what ails us, but figuring out whether treatment is better than no treatment. And if treatment only does so much, we can take credit for whatever we do to manage the hopeless mess that’s left for the rest of our not-so-bad lives.
–Dr. Lastname

My 15-year-old son needs treatment for his irritability. He gets unbelievably angry over small things, to the point that he ups and goes to his room. He agrees that things are basically OK and he’s sorry afterwards, but it happens at least once a week. We have a happy home and he has friends in school and gets good grades. I think it’s his mood that’s the problem and it causes him and our family a lot of pain. My goal is to figure out how to get him some help with psychotherapy and/or medication.

Just because someone’s in pain doesn’t mean he needs help. Pain is just part of the complete life package, along with joy, hunger, death, etc.

Of course, you’ve got less to lose and more to gain from treatment if his irritability has caused bruised knuckles, broken sheetrock, and a growing familiarity with your local police. Pain is a normal part of life, but serving life in prison isn’t.

What you’re saying, however, is that, aside from his verbal explosions, he remains in physical control, does self-motivated time-outs, retains good relationships, and has no trouble focusing on work and getting it done. No pill could improve upon that. WAIT! There is more to read… read on »

For those of us in the helping professions who overestimate our ability to help, (off-hour phone) calls for help can become a big problem. Whether you’re soft and sympathetic or blunt and tough, there’s no problem you can’t make worse by taking too much responsibility for messes that are beyond your (or anyone’s) control. If, on the other hand, you know the limits of your powers, you can respond to calls pleasantly, do your job, and still help someone without hurting your own sanity.
–Dr. Lastname

While most mental health clinicians would feel guilty admitting this, I’ve been in the biz for long enough that I don’t give a shit and I need to vent. Most of the crisis calls I get from my psychotherapy practice are senseless and irritating; they’re from patients who feel bad because they forgot to take their medications, or drank too much or when they shouldn’t, or allowed their demons to wreak vengeance on their enemies, the nearer the better, self best of all. A few call me because they’re feeling suicidal (but won’t go to the hospital) and just want me to make them feel better, which is hard when it’s late and I’m tired, and often impossible just because I don’t have that kind of power. I try to be civil, but their calls leave me feeling helpless and wondering whether I’m doing any good. Discussing their responsibility for their behavior is useless, because it usually makes them mad or apologetic. My goal is to figure out what to do with crisis calls that are really a useless pain in the ass.

Many crisis calls you receive as a shrink do a good job of showing off a patient’s worst behavior. It’s like having partial custody of a colicky child.

It’s not that their distress isn’t real and severe—it is, almost always—it’s that it causes self-defeating behavior, like drinking or mouthing off or retreating from the world, which creates a jam that is extra hard to get out of.